Iowa Admin. Code r. 441-7.1

Current through Register Vol. 46, No. 21, April 17, 2024
Rule 441-7.1 - Definitions

"Adverse benefit determination" means any adverse action taken as to any individual's benefits pursuant to an assistance program administered by the department or on the department's behalf, excluding determinations related to requests for exceptions to policy.

"Appeals section" means the director's designee who is charged with administering the department's appeals.

"Appellant" means a person, including an authorized representative acting on the person's behalf, seeking to appeal some action pursuant to this chapter.

"Assistance program" means a program administered by the department or on the department's behalf through which qualifying individuals receive benefits or services. Assistance programs include, but are not necessarily limited to, the Supplemental Nutrition Assistance Program (SNAP), Medicaid, the family investment program, refugee cash assistance, child care assistance, emergency assistance, the family planning program, the family self-sufficiency grant, PROMISE JOBS, state supplementary assistance, the healthy and well kids in Iowa (hawki) program, foster care, adoption, and aftercare services.

"Authorized representative" means a person lawfully designated by an individual to act on the individual's behalf or who has legal authority to act on behalf of the individual.

"Contested case" refers to an evidentiary hearing mandated by state or federal constitutional or statutory authority whereupon a presiding officer makes a determination pertaining to the relative rights and obligations of parties to an appeal under this chapter.

"Department" means the Iowa department of human services.

"DIA" means the Iowa department of inspections and appeals and may include presiding officers where appropriate.

"Director" means the director of the department or the director's designee.

"Enrollee" means any applicant to or recipient of benefits or services pursuant to an assistance program.

"Good cause," for purposes of this rule, shall have the same meaning as "good cause" for setting aside a default judgment under Iowa Rule of Civil Procedure 1.971.

"In-person hearing" means an appeal hearing where the administrative law judge and appellant are physically present in the same location but witnesses are not required to be physically present.

"Intentional program violation" means deliberately making a false or misleading statement; or misrepresenting, concealing, or withholding facts; or committing any act that is a violation of the Supplemental Nutrition Assistance Program (SNAP), SNAP regulations, or any state law relating to the use, presentation, transfer, acquisition, receipt, possession, or trafficking of SNAP benefits or an electronic benefit transfer (EBT) card. An intentional program violation is determined through a SNAP administrative disqualification hearing, a court conviction, or when an individual signs and returns Form 470-5530, Waiver of Right to an Administrative Disqualification Hearing, which may result in a period of ineligibility for the program, a claim for overpayment of benefits, or both.

"Managed care organization" or "MCO" has the meaning assigned to it in rule 441-73.1 (249A) and includes prepaid ambulatory health plans.

"Medicaid" means Iowa's medical assistance program administered under Iowa Code chapter 249A.

"Party-in-interest" refers to the party, including enrollees, whose rights or obligations are the subject of a contested case hearing under this chapter. Parties-in-interest may or may not be the appellant.

"Presiding officer" means an administrative law judge charged with the administration and adjudication of the contested case hearing process for a particular appeal.

"Self-represented" means representing oneself without an attorney.

Iowa Admin. Code r. 441-7.1

ARC 8003B, IAB 7/29/09, effective 9/2/09; ARC 8994B, IAB 8/11/10, effective 10/1/10; ARC 9254B, IAB 12/1/10, effective 1/1/11; ARC 0304C, IAB 9/5/12, effective 11/1/12; ARC 0487C, IAB 12/12/12, effective 2/1/2013; ARC 0583C, IAB 2/6/2013, effective 4/1/2013; ARC 0819C, IAB 7/10/2013, effective 9/1/2013; ARC 1206C, IAB 12/11/2013, effective 1/15/2014; ARC 1261C, IAB 1/8/2014, effective 3/1/2014
Amended by IAB September 3, 2014/Volume XXXVII, Number 5, effective 11/1/2014
Amended by IAB June 7, 2017/Volume XXXIX, Number 25, effective 7/12/2017
Amended by IAB March 11, 2020/Volume XLII, Number 19, effective 4/15/2020
Amended by IAB July 28, 2021/Volume XLIV, Number 2, effective 9/1/2021
Amended by IAB June 29, 2022/Volume XLIV, Number 26, effective 9/1/2022